|
R HRT ART/GRFT ANGIO
|
Facility
|
IP
|
$16,003.00
|
|
|
Service Code
|
HCPCS 93457
|
| Hospital Charge Code |
48100068
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,080.39 |
| Max. Negotiated Rate |
$15,362.88 |
| Rate for Payer: Aetna Commercial |
$12,322.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,482.34
|
| Rate for Payer: Cash Price |
$8,001.50
|
| Rate for Payer: Cigna Commercial |
$13,282.49
|
| Rate for Payer: First Health Commercial |
$15,202.85
|
| Rate for Payer: Humana Commercial |
$13,602.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,122.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,810.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,800.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,082.64
|
| Rate for Payer: Ohio Health Group HMO |
$12,002.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,200.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,080.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,960.93
|
| Rate for Payer: PHCS Commercial |
$15,362.88
|
| Rate for Payer: United Healthcare All Payer |
$14,082.64
|
|
|
R HRT ART/GRFT ANGIO
|
Facility
|
OP
|
$16,003.00
|
|
|
Service Code
|
HCPCS 93457
|
| Hospital Charge Code |
48100068
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,080.39 |
| Max. Negotiated Rate |
$15,362.88 |
| Rate for Payer: Aetna Commercial |
$12,322.31
|
| Rate for Payer: Anthem Medicaid |
$5,503.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,817.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,482.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,944.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,804.10
|
| Rate for Payer: Cash Price |
$8,001.50
|
| Rate for Payer: Cash Price |
$8,001.50
|
| Rate for Payer: Cigna Commercial |
$13,282.49
|
| Rate for Payer: First Health Commercial |
$15,202.85
|
| Rate for Payer: Humana Commercial |
$13,602.55
|
| Rate for Payer: Humana KY Medicaid |
$5,503.43
|
| Rate for Payer: Humana Medicare Advantage |
$2,817.85
|
| Rate for Payer: Kentucky WC Medicaid |
$5,559.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,122.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,810.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,381.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,613.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,082.64
|
| Rate for Payer: Ohio Health Group HMO |
$12,002.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,200.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,080.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,960.93
|
| Rate for Payer: PHCS Commercial |
$15,362.88
|
| Rate for Payer: United Healthcare All Payer |
$14,082.64
|
|
|
R HRT ART/GRFT ANGIO(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 93457
|
| Hospital Charge Code |
761P2481
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$2,130.12 |
| Rate for Payer: Aetna Commercial |
$1,944.43
|
| Rate for Payer: Anthem Medicaid |
$1,082.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$2,130.12
|
| Rate for Payer: Healthspan PPO |
$1,445.13
|
| Rate for Payer: Humana Medicaid |
$1,082.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$512.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,104.31
|
| Rate for Payer: Molina Healthcare Passport |
$1,082.66
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$210.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,093.49
|
|
|
R HRT ART/GRFT ANGIO(T
|
Facility
|
IP
|
$16,003.00
|
|
|
Service Code
|
HCPCS 93457
|
| Hospital Charge Code |
761T2481
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,080.39 |
| Max. Negotiated Rate |
$15,362.88 |
| Rate for Payer: Aetna Commercial |
$12,322.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,482.34
|
| Rate for Payer: Cash Price |
$8,001.50
|
| Rate for Payer: Cigna Commercial |
$13,282.49
|
| Rate for Payer: First Health Commercial |
$15,202.85
|
| Rate for Payer: Humana Commercial |
$13,602.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,122.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,810.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,800.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,082.64
|
| Rate for Payer: Ohio Health Group HMO |
$12,002.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,200.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,080.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,960.93
|
| Rate for Payer: PHCS Commercial |
$15,362.88
|
| Rate for Payer: United Healthcare All Payer |
$14,082.64
|
|
|
R HRT ART/GRFT ANGIO(T
|
Facility
|
OP
|
$16,003.00
|
|
|
Service Code
|
HCPCS 93457
|
| Hospital Charge Code |
761T2481
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,080.39 |
| Max. Negotiated Rate |
$15,362.88 |
| Rate for Payer: Aetna Commercial |
$12,322.31
|
| Rate for Payer: Anthem Medicaid |
$5,503.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,817.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,482.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,944.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,804.10
|
| Rate for Payer: Cash Price |
$8,001.50
|
| Rate for Payer: Cash Price |
$8,001.50
|
| Rate for Payer: Cigna Commercial |
$13,282.49
|
| Rate for Payer: First Health Commercial |
$15,202.85
|
| Rate for Payer: Humana Commercial |
$13,602.55
|
| Rate for Payer: Humana KY Medicaid |
$5,503.43
|
| Rate for Payer: Humana Medicare Advantage |
$2,817.85
|
| Rate for Payer: Kentucky WC Medicaid |
$5,559.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,122.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,810.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,381.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,613.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,082.64
|
| Rate for Payer: Ohio Health Group HMO |
$12,002.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,200.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,080.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,960.93
|
| Rate for Payer: PHCS Commercial |
$15,362.88
|
| Rate for Payer: United Healthcare All Payer |
$14,082.64
|
|
|
R HRT CORONARY ARTERY ANGIO
|
Facility
|
OP
|
$17,916.00
|
|
|
Service Code
|
HCPCS 93456
|
| Hospital Charge Code |
76102480
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,329.08 |
| Max. Negotiated Rate |
$17,199.36 |
| Rate for Payer: Aetna Commercial |
$13,795.32
|
| Rate for Payer: Anthem Medicaid |
$6,161.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,817.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,974.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,944.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,804.10
|
| Rate for Payer: Cash Price |
$8,958.00
|
| Rate for Payer: Cash Price |
$8,958.00
|
| Rate for Payer: Cigna Commercial |
$14,870.28
|
| Rate for Payer: First Health Commercial |
$17,020.20
|
| Rate for Payer: Humana Commercial |
$15,228.60
|
| Rate for Payer: Humana KY Medicaid |
$6,161.31
|
| Rate for Payer: Humana Medicare Advantage |
$2,817.85
|
| Rate for Payer: Kentucky WC Medicaid |
$6,224.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,691.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,222.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,381.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,284.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,766.08
|
| Rate for Payer: Ohio Health Group HMO |
$13,437.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,583.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,329.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,553.96
|
| Rate for Payer: PHCS Commercial |
$17,199.36
|
| Rate for Payer: United Healthcare All Payer |
$15,766.08
|
|
|
R HRT CORONARY ARTERY ANGIO
|
Facility
|
IP
|
$17,916.00
|
|
|
Service Code
|
HCPCS 93456
|
| Hospital Charge Code |
76102480
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,329.08 |
| Max. Negotiated Rate |
$17,199.36 |
| Rate for Payer: Aetna Commercial |
$13,795.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,974.48
|
| Rate for Payer: Cash Price |
$8,958.00
|
| Rate for Payer: Cigna Commercial |
$14,870.28
|
| Rate for Payer: First Health Commercial |
$17,020.20
|
| Rate for Payer: Humana Commercial |
$15,228.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,691.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,222.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,374.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,766.08
|
| Rate for Payer: Ohio Health Group HMO |
$13,437.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,583.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,329.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,553.96
|
| Rate for Payer: PHCS Commercial |
$17,199.36
|
| Rate for Payer: United Healthcare All Payer |
$15,766.08
|
|
|
R HRT CORONARY ARTERY ANGIO
|
Facility
|
OP
|
$17,366.00
|
|
|
Service Code
|
HCPCS 93456
|
| Hospital Charge Code |
48100067
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,257.58 |
| Max. Negotiated Rate |
$16,671.36 |
| Rate for Payer: Aetna Commercial |
$13,371.82
|
| Rate for Payer: Anthem Medicaid |
$5,972.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,817.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,545.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,944.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,804.10
|
| Rate for Payer: Cash Price |
$8,683.00
|
| Rate for Payer: Cash Price |
$8,683.00
|
| Rate for Payer: Cigna Commercial |
$14,413.78
|
| Rate for Payer: First Health Commercial |
$16,497.70
|
| Rate for Payer: Humana Commercial |
$14,761.10
|
| Rate for Payer: Humana KY Medicaid |
$5,972.17
|
| Rate for Payer: Humana Medicare Advantage |
$2,817.85
|
| Rate for Payer: Kentucky WC Medicaid |
$6,032.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,240.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,816.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,381.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,091.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,282.08
|
| Rate for Payer: Ohio Health Group HMO |
$13,024.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,473.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,257.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,383.46
|
| Rate for Payer: PHCS Commercial |
$16,671.36
|
| Rate for Payer: United Healthcare All Payer |
$15,282.08
|
|
|
R HRT CORONARY ARTERY ANGIO
|
Facility
|
IP
|
$17,366.00
|
|
|
Service Code
|
HCPCS 93456
|
| Hospital Charge Code |
48100067
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,257.58 |
| Max. Negotiated Rate |
$16,671.36 |
| Rate for Payer: Aetna Commercial |
$13,371.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,545.48
|
| Rate for Payer: Cash Price |
$8,683.00
|
| Rate for Payer: Cigna Commercial |
$14,413.78
|
| Rate for Payer: First Health Commercial |
$16,497.70
|
| Rate for Payer: Humana Commercial |
$14,761.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,240.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,816.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,209.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,282.08
|
| Rate for Payer: Ohio Health Group HMO |
$13,024.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,473.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,257.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,383.46
|
| Rate for Payer: PHCS Commercial |
$16,671.36
|
| Rate for Payer: United Healthcare All Payer |
$15,282.08
|
|
|
R HRT CORONARY ARTERY ANGIO
|
Professional
|
Both
|
$17,916.00
|
|
|
Service Code
|
HCPCS 93456
|
| Hospital Charge Code |
76102480
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$457.08 |
| Max. Negotiated Rate |
$17,916.00 |
| Rate for Payer: Aetna Commercial |
$1,716.14
|
| Rate for Payer: Anthem Medicaid |
$955.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$17,916.00
|
| Rate for Payer: Cash Price |
$8,958.00
|
| Rate for Payer: Cash Price |
$8,958.00
|
| Rate for Payer: Cigna Commercial |
$1,879.99
|
| Rate for Payer: Healthspan PPO |
$1,276.21
|
| Rate for Payer: Humana Medicaid |
$955.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$457.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$974.48
|
| Rate for Payer: Molina Healthcare Passport |
$955.37
|
| Rate for Payer: Multiplan PHCS |
$10,749.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$12,541.20
|
| Rate for Payer: UHCCP Medicaid |
$6,270.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$964.92
|
|
|
R HRT CORONARY ARTERY ANGIO(P
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 93456
|
| Hospital Charge Code |
761P2480
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$192.50 |
| Max. Negotiated Rate |
$1,879.99 |
| Rate for Payer: Aetna Commercial |
$1,716.14
|
| Rate for Payer: Anthem Medicaid |
$955.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$550.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$1,879.99
|
| Rate for Payer: Healthspan PPO |
$1,276.21
|
| Rate for Payer: Humana Medicaid |
$955.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$457.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$974.48
|
| Rate for Payer: Molina Healthcare Passport |
$955.37
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$385.00
|
| Rate for Payer: UHCCP Medicaid |
$192.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$964.92
|
|
|
R HRT CORONARY ARTERY ANGIO(T
|
Facility
|
IP
|
$17,366.00
|
|
|
Service Code
|
HCPCS 93456
|
| Hospital Charge Code |
761T2480
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,257.58 |
| Max. Negotiated Rate |
$16,671.36 |
| Rate for Payer: Aetna Commercial |
$13,371.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,545.48
|
| Rate for Payer: Cash Price |
$8,683.00
|
| Rate for Payer: Cigna Commercial |
$14,413.78
|
| Rate for Payer: First Health Commercial |
$16,497.70
|
| Rate for Payer: Humana Commercial |
$14,761.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,240.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,816.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,209.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,282.08
|
| Rate for Payer: Ohio Health Group HMO |
$13,024.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,473.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,257.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,383.46
|
| Rate for Payer: PHCS Commercial |
$16,671.36
|
| Rate for Payer: United Healthcare All Payer |
$15,282.08
|
|
|
R HRT CORONARY ARTERY ANGIO(T
|
Facility
|
OP
|
$17,366.00
|
|
|
Service Code
|
HCPCS 93456
|
| Hospital Charge Code |
761T2480
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,257.58 |
| Max. Negotiated Rate |
$16,671.36 |
| Rate for Payer: Aetna Commercial |
$13,371.82
|
| Rate for Payer: Anthem Medicaid |
$5,972.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,817.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,545.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,944.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,804.10
|
| Rate for Payer: Cash Price |
$8,683.00
|
| Rate for Payer: Cash Price |
$8,683.00
|
| Rate for Payer: Cigna Commercial |
$14,413.78
|
| Rate for Payer: First Health Commercial |
$16,497.70
|
| Rate for Payer: Humana Commercial |
$14,761.10
|
| Rate for Payer: Humana KY Medicaid |
$5,972.17
|
| Rate for Payer: Humana Medicare Advantage |
$2,817.85
|
| Rate for Payer: Kentucky WC Medicaid |
$6,032.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,240.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,816.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,381.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,091.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,282.08
|
| Rate for Payer: Ohio Health Group HMO |
$13,024.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,473.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,257.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,383.46
|
| Rate for Payer: PHCS Commercial |
$16,671.36
|
| Rate for Payer: United Healthcare All Payer |
$15,282.08
|
|
|
RHYTIDECTOMY; FOREHEAD
|
Facility
|
OP
|
$2,207.77
|
|
|
Service Code
|
CPT 15824
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,576.98 |
| Max. Negotiated Rate |
$2,207.77 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,207.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,128.92
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
|
|
RHYTIDECTOMY; FOREHEAD
|
Facility
|
IP
|
$6,257.00
|
|
|
Service Code
|
HCPCS 15824
|
| Hospital Charge Code |
76100217
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$813.41 |
| Max. Negotiated Rate |
$6,006.72 |
| Rate for Payer: Aetna Commercial |
$4,817.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,880.46
|
| Rate for Payer: Cash Price |
$3,128.50
|
| Rate for Payer: Cigna Commercial |
$5,193.31
|
| Rate for Payer: First Health Commercial |
$5,944.15
|
| Rate for Payer: Humana Commercial |
$5,318.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,130.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,617.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,877.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,506.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,692.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,251.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$813.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,939.67
|
| Rate for Payer: PHCS Commercial |
$6,006.72
|
| Rate for Payer: United Healthcare All Payer |
$5,506.16
|
|
|
RHYTIDECTOMY; FOREHEAD
|
Facility
|
OP
|
$2,207.77
|
|
|
Service Code
|
CPT 15824
|
| Hospital Charge Code |
76100217
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,576.98 |
| Max. Negotiated Rate |
$2,207.77 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,207.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,128.92
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
|
|
RHYTIDECTOMY; FOREHEAD
|
Facility
|
OP
|
$6,257.00
|
|
|
Service Code
|
HCPCS 15824
|
| Hospital Charge Code |
76100217
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$813.41 |
| Max. Negotiated Rate |
$6,006.72 |
| Rate for Payer: Aetna Commercial |
$4,817.89
|
| Rate for Payer: Anthem Medicaid |
$2,151.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,880.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,207.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,128.92
|
| Rate for Payer: Cash Price |
$3,128.50
|
| Rate for Payer: Cash Price |
$3,128.50
|
| Rate for Payer: Cigna Commercial |
$5,193.31
|
| Rate for Payer: First Health Commercial |
$5,944.15
|
| Rate for Payer: Humana Commercial |
$5,318.45
|
| Rate for Payer: Humana KY Medicaid |
$2,151.78
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,173.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,130.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,617.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,194.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,506.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,692.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,251.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$813.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,939.67
|
| Rate for Payer: PHCS Commercial |
$6,006.72
|
| Rate for Payer: United Healthcare All Payer |
$5,506.16
|
|
|
RHYTIDECTOMY; FOREHEAD
|
Professional
|
Both
|
$6,257.00
|
|
|
Service Code
|
HCPCS 15824
|
| Hospital Charge Code |
76100217
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$6,257.00 |
| Rate for Payer: Aetna Commercial |
$1,570.95
|
| Rate for Payer: Anthem Medicaid |
$504.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,257.00
|
| Rate for Payer: Cash Price |
$3,128.50
|
| Rate for Payer: Cash Price |
$3,128.50
|
| Rate for Payer: Cigna Commercial |
$1,478.41
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$504.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$949.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$514.24
|
| Rate for Payer: Molina Healthcare Passport |
$504.16
|
| Rate for Payer: Multiplan PHCS |
$3,754.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,379.90
|
| Rate for Payer: UHCCP Medicaid |
$2,189.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$509.20
|
|
|
RHYTIDECTOMY; FOREHEAD(P
|
Professional
|
Both
|
$1,450.00
|
|
|
Service Code
|
HCPCS 15824
|
| Hospital Charge Code |
761P0217
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,570.95 |
| Rate for Payer: Aetna Commercial |
$1,570.95
|
| Rate for Payer: Anthem Medicaid |
$504.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,450.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$1,478.41
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$504.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$949.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$514.24
|
| Rate for Payer: Molina Healthcare Passport |
$504.16
|
| Rate for Payer: Multiplan PHCS |
$870.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,015.00
|
| Rate for Payer: UHCCP Medicaid |
$507.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$509.20
|
|
|
RHYTIDECTOMY; FOREHEAD(T
|
Facility
|
IP
|
$4,807.00
|
|
|
Service Code
|
HCPCS 15824
|
| Hospital Charge Code |
761T0217
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$624.91 |
| Max. Negotiated Rate |
$4,614.72 |
| Rate for Payer: Aetna Commercial |
$3,701.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,749.46
|
| Rate for Payer: Cash Price |
$2,403.50
|
| Rate for Payer: Cigna Commercial |
$3,989.81
|
| Rate for Payer: First Health Commercial |
$4,566.65
|
| Rate for Payer: Humana Commercial |
$4,085.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,941.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,547.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,442.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,230.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,605.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$961.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$624.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,490.17
|
| Rate for Payer: PHCS Commercial |
$4,614.72
|
| Rate for Payer: United Healthcare All Payer |
$4,230.16
|
|
|
RHYTIDECTOMY; FOREHEAD(T
|
Facility
|
OP
|
$4,807.00
|
|
|
Service Code
|
HCPCS 15824
|
| Hospital Charge Code |
761T0217
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$624.91 |
| Max. Negotiated Rate |
$4,614.72 |
| Rate for Payer: Aetna Commercial |
$3,701.39
|
| Rate for Payer: Anthem Medicaid |
$1,653.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,749.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,207.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,128.92
|
| Rate for Payer: Cash Price |
$2,403.50
|
| Rate for Payer: Cash Price |
$2,403.50
|
| Rate for Payer: Cigna Commercial |
$3,989.81
|
| Rate for Payer: First Health Commercial |
$4,566.65
|
| Rate for Payer: Humana Commercial |
$4,085.95
|
| Rate for Payer: Humana KY Medicaid |
$1,653.13
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,669.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,941.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,547.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,686.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,230.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,605.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$961.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$624.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,490.17
|
| Rate for Payer: PHCS Commercial |
$4,614.72
|
| Rate for Payer: United Healthcare All Payer |
$4,230.16
|
|
|
RIABNI 10mg (100mg SDV)
|
Facility
|
OP
|
$3,906.56
|
|
|
Service Code
|
HCPCS Q5123
|
| Hospital Charge Code |
25004313
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.42 |
| Max. Negotiated Rate |
$3,750.30 |
| Rate for Payer: Aetna Commercial |
$3,008.05
|
| Rate for Payer: Anthem Medicaid |
$1,343.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$41.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,047.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$57.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$55.92
|
| Rate for Payer: Cash Price |
$1,953.28
|
| Rate for Payer: Cash Price |
$1,953.28
|
| Rate for Payer: Cigna Commercial |
$3,242.44
|
| Rate for Payer: First Health Commercial |
$3,711.23
|
| Rate for Payer: Humana Commercial |
$3,320.58
|
| Rate for Payer: Humana KY Medicaid |
$1,343.47
|
| Rate for Payer: Humana Medicare Advantage |
$41.42
|
| Rate for Payer: Kentucky WC Medicaid |
$1,357.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,203.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,883.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,370.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,437.77
|
| Rate for Payer: Ohio Health Group HMO |
$2,929.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$781.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$507.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,211.03
|
| Rate for Payer: PHCS Commercial |
$3,750.30
|
| Rate for Payer: United Healthcare All Payer |
$3,437.77
|
|
|
RIABNI 10mg (100mg SDV)
|
Facility
|
IP
|
$3,906.56
|
|
|
Service Code
|
HCPCS Q5123
|
| Hospital Charge Code |
25004313
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$507.85 |
| Max. Negotiated Rate |
$3,750.30 |
| Rate for Payer: Aetna Commercial |
$3,008.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,047.12
|
| Rate for Payer: Cash Price |
$1,953.28
|
| Rate for Payer: Cigna Commercial |
$3,242.44
|
| Rate for Payer: First Health Commercial |
$3,711.23
|
| Rate for Payer: Humana Commercial |
$3,320.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,203.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,883.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,171.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,437.77
|
| Rate for Payer: Ohio Health Group HMO |
$2,929.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$781.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$507.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,211.03
|
| Rate for Payer: PHCS Commercial |
$3,750.30
|
| Rate for Payer: United Healthcare All Payer |
$3,437.77
|
|
|
RIABNI 10mg (500mg SDV)
|
Facility
|
OP
|
$19,532.80
|
|
|
Service Code
|
HCPCS Q5123
|
| Hospital Charge Code |
25004314
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.42 |
| Max. Negotiated Rate |
$18,751.49 |
| Rate for Payer: Aetna Commercial |
$15,040.26
|
| Rate for Payer: Anthem Medicaid |
$6,717.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$41.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,235.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$57.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$55.92
|
| Rate for Payer: Cash Price |
$9,766.40
|
| Rate for Payer: Cash Price |
$9,766.40
|
| Rate for Payer: Cigna Commercial |
$16,212.22
|
| Rate for Payer: First Health Commercial |
$18,556.16
|
| Rate for Payer: Humana Commercial |
$16,602.88
|
| Rate for Payer: Humana KY Medicaid |
$6,717.33
|
| Rate for Payer: Humana Medicare Advantage |
$41.42
|
| Rate for Payer: Kentucky WC Medicaid |
$6,785.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,016.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,415.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,852.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,188.86
|
| Rate for Payer: Ohio Health Group HMO |
$14,649.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,906.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,539.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,055.17
|
| Rate for Payer: PHCS Commercial |
$18,751.49
|
| Rate for Payer: United Healthcare All Payer |
$17,188.86
|
|
|
RIABNI 10mg (500mg SDV)
|
Facility
|
IP
|
$19,532.80
|
|
|
Service Code
|
HCPCS Q5123
|
| Hospital Charge Code |
25004314
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,539.26 |
| Max. Negotiated Rate |
$18,751.49 |
| Rate for Payer: Aetna Commercial |
$15,040.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,235.58
|
| Rate for Payer: Cash Price |
$9,766.40
|
| Rate for Payer: Cigna Commercial |
$16,212.22
|
| Rate for Payer: First Health Commercial |
$18,556.16
|
| Rate for Payer: Humana Commercial |
$16,602.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,016.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,415.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,859.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,188.86
|
| Rate for Payer: Ohio Health Group HMO |
$14,649.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,906.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,539.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,055.17
|
| Rate for Payer: PHCS Commercial |
$18,751.49
|
| Rate for Payer: United Healthcare All Payer |
$17,188.86
|
|
